ATI RN
Multi Dimensional Care | Final Exam
1. A client who had an elective below-the-knee amputation reports pain in the foot that was amputated. What is the best response by the nurse?
- A. The pain will go away after the swelling decreases.
- B. That is phantom limb pain.
- C. Your foot has been amputated, so you are not having pain in that foot.
- D. On a scale of 0-10, how would you rate your pain?
Correct answer: D
Rationale: The correct response is to assess the pain intensity by asking the client to rate their pain on a scale of 0-10. This helps the nurse to effectively manage the client's pain. Choice A is incorrect as it dismisses the client's pain without proper assessment. Choice B is incorrect as it assumes the pain is phantom limb pain without assessing the client's current condition. Choice C is incorrect as it invalidates the client's pain experience and does not address the issue at hand.
2. A nurse is caring for an immobile client. What is the priority assessment of this client?
- A. Palpate for edema
- B. Auscultate for bowel sounds
- C. Inspect the skin for injury
- D. Auscultation of lung sounds
Correct answer: C
Rationale: Inspecting the skin for injury is crucial to prevent pressure ulcers and other complications in immobile clients.
3. A client has an abdominal incision. The surgical wound was closed with 10 sutures. This surgical wound is healing by what process?
- A. Primary intention
- B. Binary intention
- C. Secondary intention
- D. None of the Above
Correct answer: A
Rationale:
4. A client has AIDS. Which of these findings indicate possible infection?
- A. Respirations; 22 breaths per minute
- B. Client ambulates 20 feet
- C. Purulent drainage
- D. Oxygen saturation; 97% on room air
Correct answer: C
Rationale:
5. A client is recovering from a fractured radius that occurred 7weeks ago. Which state of bone healing occurs at this time as the callus is restored and transformed into bone?
- A. Stage 3
- B. Stage 5
- C. Stage 1
- D. Stage 4
Correct answer: D
Rationale:
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